Treatment of chronic hepatitis C virus infection in the HIV-infected patient
- Jürgen Kurt Rockstroh, MD
Jürgen Kurt Rockstroh, MD
- Professor of Medicine
- Department of Medicine I, University of Bonn, Germany
The consequences of hepatitis C virus (HCV) infection in HIV-infected patients are significant and include accelerated liver disease progression, high rates of end-stage liver disease, and shortened lifespan after hepatic decompensation, in particular among those with more advanced immunodeficiency [1-3]. In the era of potent antiretroviral therapy, end-stage liver disease remains a major cause of death among HIV-infected patients who are coinfected with HCV [4,5].
This topic will address the management of the HIV/HCV-coinfected patient. The epidemiology, natural history, diagnosis, and evaluation of this patient population are discussed elsewhere. (See "Epidemiology, natural history, and diagnosis of hepatitis C in the HIV-infected patient" and "Evaluation of the HIV-infected patient with chronic hepatitis C virus infection".)
Discussion of acute HCV infection is found elsewhere. (See "Clinical manifestations, diagnosis, and treatment of acute hepatitis C in adults".)
Guidelines for the diagnosis and management of HCV infection produced jointly by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) are updated on an ongoing basis and can be accessed at www.hcvguidelines.org . Management of coinfection is addressed in the US Department of Health and Human Services guidelines for the use of antiretroviral agents in adults and adolescents . In addition, the European Association for the Study of the Liver (EASL) HCV guidelines were updated in 2016 , and the coinfection guidelines of the European Clinical AIDS Society were updated in 2016 [9,10]. The discussion in this topic is generally consistent with these guidelines.
GOALS OF THERAPY
The objective of HCV antiviral treatment is to cure HCV infection, as reflected by a sustained virologic response, which is associated with substantial reductions in liver-related morbidity and mortality.
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- GOALS OF THERAPY
- Sustained virologic response as cure
- Clinical benefits of cure
- EFFECT OF HIV INFECTION ON RESPONSE TO HCV TREATMENT
- PATIENT EVALUATION
- Evaluation to guide management decisions
- Deciding when to treat
- ANTIRETROVIRAL MANAGEMENT
- ART-naïve patients
- - Selection of ART regimen
- - Timing of ART initiation
- ART-experienced patients
- HCV REGIMEN SELECTION
- Regimen options by genotype
- - Genotype 1 infection
- - Genotype 2 infection
- - Genotype 3 infection
- - Genotypes 4, 5, and 6 infection
- Potential drug interactions with ART
- - Ribavirin
- - Sofosbuvir
- - Ledipasvir-sofosbuvir
- - Sofosbuvir-velpatasvir
- - Elbasvir-grazoprevir
- - Ombitasvir-paritaprevir-ritonavir plus dasabuvir
- - Daclatasvir
- - Simeprevir
- PATIENT MONITORING
- BARRIERS TO CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS